Lack of Robust Appraisal System Allowed Paterson to Continue Unheeded for Far Too Long

The findings of a review carried out at Spire Healthcare, have revealed that appraisal systems at two of their private hospitals were seriously lax and allowed an unacceptably poor standard of treatment to continue unheeded for far too long.

The findings of a review carried out at Spire Healthcare, have revealed that appraisal systems at two of their private hospitals were seriously lax and allowed an unacceptably poor standard of treatment to continue unheeded for far too long.

Mr Paterson was 'excluded' from Heart of England NHS Trust in 2011. He was later suspended from practising by the General Medical Council (GMC) in 2012 and is expected to face a full fitness-to-practice hearing. West Midlands Police have launched a criminal inquiry into his practices.

The review's findings have brought to light serious flaws within the appraisal system operating at two private hospitals run by Spire Healthcare - Little Aston and Parkway. This failed to identify malpractice and allowed it to go unnoticed.

To address this, a more robust internal investigation system would reduce the likelihood of issues being 'hidden' in future. Whilst a more comprehensive review may be unpopular among some health professionals because of the time needed to carry it out, this kind of system would help draw attention to poor standards of care and put a stop to bad practice more quickly.

Consultants at Spire Healthcare's hospitals are required to submit an appraisal at least once a year, failing which practising privileges are withdrawn. However, despite Paterson failing to do so, he continued to be allowed to practise there. On occasions, he had failed to submit an appraisal for two years. The review also revealed that both Parkway and Little Aston Hospitals still have problems with consultants not supplying up-to-date appraisals and only 50% of consultants at the two hospitals are compliant with this. Without more stringent application of the policy, the situation is unlikely to improve. In addition, the review shows that hospital directors' job descriptions placed a heavy emphasis on business imperatives and said little about their responsibility for patient safety.

A number of complaints were made about Mr Paterson by his patients to the GMC. However, Spire Healthcare failed to consider these alongside the other concerns being raised. This led them to underestimate the extent of the problem. Mr Paterson was told to stop performing 'cleavage-sparing' mastectomies in 2007, but continued to carry out this procedure without reprisal.

In too many instances, I receive enquiries from people who have reached the end of the process of bringing a formal complaint with their medical provider, and have received a wholly inadequate response. They feel that the only way that the matter can be properly investigated is by bringing a claim for compensation for medical negligence. This is not the way it should be. If the NHS and private medical providers are looking for ways to reduce negligence claims, in addition to focusing on improvements to the quality of treatment provided, they also should invest in dealing with complaints, providing a full investigation and explanation, not just to what they perceive the issues may be, but by ensuring they actually address patients' concerns.

The proposed 'duty of candour' requirement is a first step towards building a healthcare system that is rooted in openness, honesty and the general principle of being able to learn from mistakes and ensure they are never again repeated. However, the feedback received about individual doctors must be brought together and considered as a whole in order to assess performance. The ability to gather and swiftly deal with such information will help to make sure that colleague and patient feedback isn't futile and rogue practitioners can be identified and stopped more quickly.

Suzanne Trask is a partner and medical negligence specialist at Bolt Burdon Kemp.